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HomeMy WebLinkAboutBLD2011-01020 Cancelled Garage - BLD Permit / Conditions - 1/10/2012 Inspection Line(360)427-7262 MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670, ext.352 Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton, WA 98584 RESIDENTIAL BUILDING PERMIT BLD2011-01020 OWNER: LYLE GELBACH RECEIVED: 12/30/�011 CONTRACTOR: DALE DEFOREST CONSTRUCTION 1.360.250.2811 LICENSE: DEFORD*1181-8 EXP: 9/16/2 ISSUED: 2/6y2012 SITE ADDRESS: 71 E OKONEK RD GRAPEVIEW EXPIRES: .8'/6/2012 PARCEL NUMBER: 121082190080 LEGAL DESCRIPTION: TRACT 8 OF GOUT LOT 1 &TAX 1404 EX* LOT: B OF SP#1247 PROJECT DESCRIPTION: DIRECTIONS TO SITE: GARAGE HWY 3 TO OKONEK DDRESS General Information Construction&Occupan y I f tion Square Footage Information No. of Bedrooms: Type f n r.: VB Type of Use: SF Insp.Area: No. of Bathrooms: Oc . rou U Lot Size: Deck: Type of Work: ACC Dist.. 5 No. of Stories: 1 O oa Building: Garage-Detached 864 Valuation: $ 33,393. 0 Building H ' ht: Occ. atus rima Basement: Manufactured Home I formation Set ck Inf ati Shoreline&Planning Information Make: Leng Ft. Fron It 0.0 Shoreline: Ft. Water Body: Re 63 . Ft. Slope: Ft. SEPA?: Model: Widt Ft. i e 1: N 5.0 Ft. Shoreline Desig.: Year: Serial No. Side 2: S 84.0 Ft. Comp. Plan Desig.: Plumbing Fixtures Mechanical Fixtures FEES Type =ty Type Qty. Type By Date Amount Receipt Plan Check Fee TW 12/30/201 $287.14 S1201100000001 EH Plan Review TW 12/30/201 $ 103.00 S1 201 1 00000001 Planning Review Fee TW 12/30/201 $205.00 S120110000000i Building State Fee LDK 1/10/2012 $4.50 S1201200000001 Building Permit Fee LDK 1/10/2012 $482.15 S1201200000001 Total $ 1,081.79 BLD2011-01020 Please refer to the following pages for conditions of this permit. Page 1 of 5 CASE NOTES FOR BLD2011-01020 C NDITIONS FOR BLD2011-01020 1) Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries, Contractor Compliance Division. There are potential risks and monetary liabilities to the homeowner for using an unregistered contractor. Further information can be obtained at 1-800 - The person signing this condition is either the homeowner, agent for the owner or a registered contractor according to WA state law. X. 2) Owner s responsible to post the assigned address and/or purchase and post private road signs in accordance with Mason County Title 14.28. X , 1 3) All approved plans are required to be on-site for inspection purposes. If an inspection is called for and plans are not available on site, then approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and must be collected by the Building Departmto any further inspections being performed or approvals granted. X 4) The plan review check list and corrections are part of the approved plans and must remain thereto. It is the responsibility of the applicant to make the corrections indicated on the plans. Once the plans are marked "APPROVED", they shall not be changed or altered without authorization from the Building Official. The permit holder is responsible to retain the complete approved set of plans on site for the duration of the project. Failure to comply and/or removal ed documents will result in failure of required building inspections. X 5) This structure is approved as un-heated space. If at any time this building is to be used for anything other than what it is approved for, a change of use permit shall lied for, reviewed and approved prior to the change. X rl 6) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED, NATIVE SOIL. X 7) The"approved" site plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved" site plan is not on site, then approval will n e granted. In addition, a re-inspection fee (refer to current fee schedule, minimum 1 hour)will be charged and shall be collected by the Building Dep e prior to any further inspections being performed or approvals granted. X 8) REQUIREMENTS FOR ROOF COVERINGS. Roof coverings shall be applied in accordance with the applicable provisions of the current code and the manufacturer' 'nstallation instructions. X BLD2011-01020 Please refer to the following pages for conditions of this permit. Page 2 of 5 9) A Mason County Stormwater Management Worksheet was completed and signed as part of this building permit application. Design, sizing, placement, inspection and maintenance of stormwater management systems shall be the responsibility of the owner/agent of the developed parcel. It is the owner/agent/contractor's responsibility to ensure that Mason County Department of Public Works has approved the stormwater site plan for this parcel prior to the commencement of any development activities. *NOTE if Stormwater Management option "A"was selected on the Small Parcel Stormwater Management Application/Worksheet the document entitled "Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan" constitutes an approved plan based on the criteria listed on the application/worksheet. If the development has, or will have, a septic/drainfield system you are responsible for contacting Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this, or any other, parcel. You may also wish to c e septic design professional involved with the project. By calling for a final inspection of the building permit the owner/agent/contracto i ackn wle ing that all components of the stormwater management system have been installed as approved on the stormwater site plan. X 10) Owner/builder assumes all responsibility if drainfield/reserve area is encumbered. A. Drainfield/ Reserve requires a 10ft setback from all footing/foundations. B. Septic taD4aj requires 5ft setback from all footing/foundations. C. No f datio rains within 30ft, down gradient of drainfield/reserve area. X 11) Concrete used for basement walls, foundation walls, exterior walls, porches, carport slabs, steps exposed to the weather, garage floor slabs and other vertical con ork exposed to the weather shall have a minimum compressive strength of 3000 psi (IRC Table R402.2). X 12) This structurej ited to U-occupancy use only (private garages, carports, sheds, and agricultural buildings.) Any other use will be in violation of the internation o an Mason County Regulations unless a"Change of Use" permit is applied for, reviewed and approved. X 13) All construction must meet or exceed all local ordinances and the international codes requirements as adopted and amended by Mason County and the State of WashinqJDA,Occupancy is limited to the approved and permitted classification. Any non-approved change of use or occupancy would result in permit revocati X 14) Provisions for surface/subsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact adjacent parcels. Under the requirements of Mason County Stormwater Ordinance, either private ditches and drains will meet requirements of the stormwater ordinance or prior approval will be granted to use an existing utility and drainage easement dedicated for that specific purpose. For further information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access connecting from a Mason County Road, Contact the Mason County Public Works Department prior to construction at Ext 450. For any construction which is proposed to be loca n 25'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may affect your project. X 15) Placement of cuf ust comply with standards set forth per the international codes regarding descending and/or ascending slopes. X 16) All ch s to proved" building plans that effect compliance with the international codes as amended and adopted, or any other Mason County ordin a or a lation, must be reviewed and approved by Mason County prior to construction. X BLD2011-01020 Please refer to the following pages for conditions of this permit. Page 3 of 5 17) CONSTRUCTION PROCESS TO BE FIELD CORRECTED AS REQUIRED PER MASON COUNTY BUILDING DEPARTMENT AND THE ADOPTED BUILDING CODE. The construction of the permitted project is subject to inspections by the Mason County Building Department. All construction must be in conformance with the intern codes as amended and adopted by Mason County. Any corrections, changes or alterations required by a Mason County Building Xspector sh\ be ma prior to requesting additional inspections. 18) All property lines shall be clearly identified at the time of foundation inspection. X 19) All building permits shall have a final inspection performed and approved by the Mason County Building Department prior to permit expiration. The failure to request ar,,Osrspe ction or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason Couces and building regulations. X 20) All permits expire 180 days after permit issuance, or 180 days after the last inspection activity is performed. The Building Official may extend the time for action for a p of exceeding 180 days, upon the receipt of a written extension request indicating that circumstances beyond the control of the permit holder have r ve action from being taken. No more than one extension may be granted. X 21) Pressure tr wood manufactured after January 1, 2004 may contain high concentrations of copper which could quickly corrode metal fasteners, connectors d hing. Install metal connectors approved for contact with the new types of pressure treated material. X 22) Retaining walls needed to support a surchar Euca structures, roads, or to support slopes, shall require a separate building permit and approval prior to construction of the retaining wall. X 23) By definition, propane tanks and heatpumps are structures, which must meet setback conditions. Please check your"Approved Site Plan"to ensure these str es meet the setback conditions listed. r X 24) Landings an irs must meet the same setback conditions as any permitted structure; and, must be shown on your site plan. Please check your "Approved��Pla "to ensure these structures are shown and meet the setback conditions listed. X 25) Approv pe ensions and setbacks on submitted site plan. Setbacks are measured from the furthest projection of the structure. X 26) The proposed project must be consistent W� h all a cable policies and other provisions of the Shoreline Management Act, its rules, and the Mason County Shoreline Master Program. X !0 27) All construction and demolition debris must be removed from the site after project completion. Proper di s I of n truction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. X BLD2011-01020 Please refer to the following pages for conditions of this permit. Page 4 of 5 This permit becomes null and void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended for a period of 180 days at any time after work is commenced. Evidence of continuation of work is a progress inspection within the 180 day period. Final inspection must be approved before building can be occupied. Proof of continuation o ork is by.means-OVa progre spection.The owner or the agent on the owners behalf, represents that the information provided is accurate and grants employees of Ma n Co IheihQve-dvscriiNd property and structure ir re ew and inspection. OWNER OR AGENT: DATE BLD2011-01020 Please refer to the following pages for conditions of this permit. Page 5 of 5 oo' . o CONCRETE MECHANICAL MANUFACTURED HOME m Date By Gas Piping Footings/Setbacks Ribbons IOU o Interior Date By Interior-Date By Date ay > oExterior Date By Exterior-Date By set-up _ Point Load/Isolated Footings INSULATION _ Date By BG 1 SLAB INSULATION r Date By Data By FIRE DEPARTMENT m Foundation Walls Floors Date By Date By Data By DECKS FRAMING Wails Date By Date By Data By PROPANE TANKS PLUMBING vault Date ey Date By OTHER Groundwork Attic Date By Date By Type.Date By D.W.V DRYWALL Type. Int Brace Wall Date By W Date By pate By r FINAL INSPECTION v y Water Line r�yYf� Fire SeparationCD N CDDate By Date By Date By CD s Pass or Request inspect. o s y SP. Fail Date Date Done By Comments o o hi f 8 �y37-'jLC- V--47-S "o/<To F/X O C-1 Y/ti_ - - Z Z-a-,/ 7�/c2 NvTo o� �� Q —L 'to-, << Cn U dL a, � r a I' Ss �-7- z I L f 2 Pr- �� sAc f}T/o�✓ N 0 CD 3 sv co m 0 Pe{mit '�1 " I�ZC� MASON COUNTY BUILDING 111 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location -7( L' 04 L 1CJ This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be corrected to gain compliance a r,J, A k2e, O��., ✓emu C �. .Lc5 T .v-�r� c,'(C✓y /�✓�v� Sr�✓tic-ft..✓G- $L U G.JL 4 1' �l0 . 3). T v? w l 1l ►,.l ave vp A 6P Z��,. v�,.� 4 ,-t Z - tgoo 1v 4. 'tiSThlG . 6-r. it � i✓�s 7�v-� �u2 u . All T-ot -ta tiT 131-J Ar,�J r r►v� 'rVt rG S' Yil IjD. i o i'�zv s ►I 1G . �. 5 �'� y►�, IS v�Nf c �.V- - y►n,..S'� rc.Na , c� I rt�..1 vim.,t-L.� „► IL C L� �t..r-d�.c� t7J/..i. PJoG•r S ✓'tom.•- �p�f.-.^-� S-C t� l.�LtC�t-+2- 1'►i►�v►1 S: l t f 7� �3 T� �171 A2,4N You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK .Call for re-inspection when corrections are made before continuing please contact our office Make corrections, items will be checked on next inspection regarding possible structural (] OK to damage incurred by recent "natural/man made" This is not a complete inspection disasters.This is Nora Date�?7-1 Z Department 0 L,� CORRECTION NOTICE. Inspector L QV, V�L 4 N� ,#T , ' 'rl* 'I4 ' T Imah, T '—*qr Permit# MASON COUNTY BUILDING III 426 W. CEDAR SHELTON, WASHINGTON 98584 (360) 427-9670 CORRECTION NOTICE Job Location 71 S z2 This structure has been inspected by Mason County Building Department and the following VIOLATION of County Laws and Ordinances has been found: Items listed below must be corrected to gain compliance Off!��✓ i/� �'I ', ��y Qz- mot/ OG c�G- -y C?© You are hereby notified that the above corrections shall be made BEFORE PROCEEDING WITH ANY FURTHER WORK ❑ Call for re-inspection when corrections are made before continuing ❑ Please contact our office ❑ Make corrections, items will be checked on next inspection regarding possible structural ❑ OK to damage incurred by recent "natural/man made" ❑ This is not a complete inspection disasters.This is NOT a Date -/1- Department CORRECTION NOTICE. Inspector �.. ■ 'so N� ��T , I rl* ' THIa T,-- * qu Iq V F:j- lNi W. womm X PLANNING: FROM THE FURTHEST LPLRLO BACOMTKS ARE MEASURED I T ON OF HE BUILDING r APPROVED :. SITE PLAN REQUIRED TO BE ON SITE I 8y Date 1 �7 7V C z/ N RECEIVED DEC 3 0 2011 426 W. CEDAR ST. Name)� *Y Parcel# I l� 20 BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 1 of 2) Per Mason County Code,Title 14,Chapter 14.48 a stormwater site plan is required whenever a building application is made for residential development,or redevelopment',with more than 2,000 square feet of impervious surface'. 'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment. 'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces. To Calculate Impervious Surfaces Please Complete This Table Surface Type Length X Width = Area ' All dimensions in feet Buildings X � X = Measurements for buildings are taken at the X _ perimeter of the farthest projections(example: eaves/gutters) X = Driveways 130o X S = O X = Length of drive begins at the right of way X = Parking Areas X = S7 b X = Any paved, gravel or packed area per definition above table X = Patios/Walks X = SO Any paved, gravel or packed area per definition X — above table X = Others X = X = If the total impervious area of the proposed site X = development is greater than 2000 square feet a Small Parcel Stormwater Site Plan is Required Total Impervious Surface Area(sum of all areas) 13(o I If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read,acknowledge and sign below. Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- de e ' fo ' w and inspection as may be required. ? X1111J Owner/Age Ct/Contractor)pircle one)Date: J ( 1 1 If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign the information provided on page 2 of 2. Page 1 of 2 Nam )[ �2 Parcel# ) 1 a ► ')()06 BLD# Mason County Department of Community Development Small Parcel Stormwater Management Application/Worksheet (page 2 of 2) Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity. Title 14, Chapter 14.48 of the Mason County Code(MCC)regulates compliance requirements for Stormwater Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website: http//www.co.mason.wa—us/code/commissioners/index.htm Please follow the links to"Title 14,Chapter 14.48 Stormwater Management". Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan (Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document entitled"Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan". This document will assist you in preparing the necessary information and plans for Public Works to review and approve. Per Department of Public Works this document will constitute an approved plan if all of the relevant details*are to be installed in their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval. A design by a registered professional may be required for more complex sites. *These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan on the pages that begin with"Handout' PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE A)'X The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel. If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at: Phone:(360)-427-9670 EXT.450 Mail:P 0 Box 1850, Shelton WA 98584 Physical:415 N 6th St, Shelton WA 98584 If this development has,or will have,a septic/drainfield system you may need to contact Mason County Division of Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason County Division of Environmental Health can be reached at: Phone:(360)-427-9670 EXT.352 Mail:P 0 Box 1666, Shelton WA 98584 Physical:426 W Cedar St, Shelton WA 98584 A condition will be added to the building permit that states, in part,that all conditions the stormwater site plan will be met prior to a request for fmal inspection of the building permit. Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above- cn a erty for review and inspection as may be required. 1 3 � I }{ Owner/Agen ontracto (circle one)Date: Page 2 of 2 MASON COUNTY Mason Co ty Permit Center Use: DEPARTMENT OF COMMUNITY DEVELOPMENT DDR@3I 1 -'oo 117 411 N. Fifth Street/P.O. Box 186, Shelton WA 98584 360.427.9670 ext. 352 Date Rcvd I a_3 V --- 1 Request for Administrative Variance for Reduction in the Required Setbacks ($115.00) For administrative review, the minimum variance on a setback request is 5 feet from the side yard lot lines and 10 feet for front and rear lot lines or any access easement. Request for further reduction requires a standard variance. Setbacks are measured from the furthest projection of the structure, including roof eaves. Applicant/Owners: Mailing Address: UY, Y` � C City: tl Jt..�'.(h'"✓t�.4.,. State: u/� Zip: Telephone: (2 573) Email: Ltt/ If this reduction is tied to a building permit, please give permit case number. BLD Parcel Number(s): Zoning Site Address: G iC c I't C— Requested setback variance: ft. ❑ Front ❑ Rear XSide �— ft ❑ Front ❑ Rear ❑ Side ft. ❑ Front ❑ Rear ❑ Side ft ❑ Front ❑ Rear ❑ Side Front Setbacks—From access easements and road right of ways. Minimum 10 feet. Rear Setbacks—From the rear property line. Minimum 10 feet. Side Setbacks—From the side property line. Minimum 5 feet except for certain shoreline designations. An illustrated site plan is required. Your site plan must show the following: north arrow, abutting street or easements, set backs to all property lines and existing buildings, slopes, surface water, wetlands, critical areas, septic, well and driveway. Show all proposed new development. 1ACommunity Development\PACWARIANCES�Admin Variance.doc Edited on 7/ VI FRONT AND OR REAR YARD REDUCTION REQUESTS: For existing lots of record as of March 5, 2002; You must meet one of the following: 2) One of the following exists on the lot(check all that apply): ❑ a) steep slopes, wetlands, or streams present; ❑ b) soils that restrict building or septic development; ❑ c) lot width at the front yard line of no more than 50 feet; ❑ d) lot size of no more than one-fourth acre; ❑ e) existing improvements of buildings, septic systems, and well areas. SIDE YARD REDUCTION REQUESTS: For existing lots of record as of March 5, 2002; You must meet one of the following: 2) One of the following exists on the lot (check all that apply): ❑ a) steep slopes, wetlands, or streams present; ❑ b) soils that restrict building or septic development; ❑ c) lot width at the front yard line of no more than 50 feet; ❑ d) lot size of no more than one-half acre• e) existing improvement of buildings, se stems, anc areas. Explain how these circumstances preclude a reasonable development proposal from meeting the etback standard for Rural Residential 2.5, 5, 10, or 20 zones. qAKI%_� Owner/Agent(please indica$e) -e�� Signature Date (dTi� � Ofidal Use OnlyUse Only Approved by: .14 Date �CZ� � Denied by: Date Reason for denial: 1ACommunity Development\PACWARIANCES�Admin Variance.doc Edited on 7/ MASON COUNTY PERMIT NO. BUILDING PERMIT APPLICATION 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner i A4L Company Name J�ak- -F0-P Mailing Address .a 'may 7691 / Mailing Ad ress - 9 C ' N State l3_ Zip Code = C' State Zip Code�ja7 Phone� 6.4 7 SP t' O I Other Ph3 � 7 f Phone c3 5 t? f Other Ph. Lien/Title Holder - Contractor Reg. Q&E( XZ$ I I t LPExp. E mail address E Mail Address Drivers Lic. DOB Drivers Lic. f-a G' L^f DOB f S 5 SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic_--'>elt Connect to Water System Name of Water System Well Water System Name of Water System )� �� PARCEL INFORMATION- 12 Digit Parcel No Fire District Legal Description Site Address (Please include street name, street number and ity) -7 i 0,LK,:5N6 Directions to ite [1--,3�F- G'�V-j LOW ry e % Qa c Tcs-t L `7 Will timber be cut and sold in parcel preparation?Yes/ Is property within 200' of Saltwater Lake Rlver/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% 'S� Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Ye o TYPE OF JOB - New > Add Aft Repair Other- — PRIMARY RESI ERCE ❑ SEASONAL E]Use of Building s F Describe WorkR�� = -" No. of Bedrooms No.of Bathrooms Square Footage- 1st Floor 2nd Floor 37d Floor Basement Deck Covered Deck Other Sq.ft. Garage� Attached Detached �.Carport Attached Detached MANUFACTURED HOME ORMA - Model Year Length Width Serial No. edrooms No. of Bathrooms Type of Heat Purchase Price S Replace nit? Yes/No Installer Name Certification No. 0V"S:E /BUILDER Acimowledg?s submission of ina=rate information may result in a stop work order or permit revomtion.Acknowledgement cf such is by signahue below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is rewired from any easement holder,or any other party in interest regarding this appfcation or the work proposed in the application,I have obtained permission from them to apply for this permit and mnduc:t the work proposed. The owner or agent on owners behalf,represents that the information provided is accurate and grants employees of Mason County across to the above described property and structure for review and inspection. OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X -- Date* l � j Owner/ wne-s Representative/Contactor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department I V (,q Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site InsDection Plan Review Fee EH Review Fee Plumbin2& Base Fee Planning Review Fee Mechanical &Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES